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Yellow on guidelines for general practitioners with home care for Covid patients

3 years ago babelfish

Yellow on guidelines for general practitioners with home care for Covid patients

Are there or aren't there guidelines for primary care physicians with home care for Covid patients? The words of Professor Palù and the controversy between hospital doctors and family doctors

"What hasn't worked is the family doctor who makes home visits and has methods of home care." To say it was the p resident of Aifa Giorgio Palù during the program Half an hour more by Lucia Annunziata. 

Because we need national guidelines for primary care doctors with home care for Covid patients

Now that a vaccination plan is ready, "we should focus on what went wrong and, if I can say something as a stimulus, we should think of territorial medicine, what perhaps did not work", Palù said in half an hour more on Rai Tre, meaning the possibility for a family doctor to have precise guidelines on drugs and tests to intervene on inflammation quickly "in the home".

For Palù, in short, “we should focus a little more on this, on the guidelines for patients to be treated at home, which would prevent the saturation of hospital beds and for which, alas, we must impose the red zones”. Also in consideration of the new variants, "we should focus on home care and the use of monoclonal antibodies in the first 72 hours from the onset of symptoms, which we do not yet have available".

What Palù (Aifa) said

The microbiologist from the University of Padua states that the key to avoiding overcrowding in hospitals lies in home care for patients with less acute symptoms. “Carrying out those few tests to use cortisone and low molecular weight heparin, this would help us avoid hospital saturation – continued prof. Palù -. We must focus on home care also with the use of monoclonal antibodies in the first 72 hours from the onset of symptoms, but we still do not have them available ". The vaccine remains the weapon of prevention even if variants have intervened "but it is a normal adaptation of the virus, vaccines are able to cover them, even Johnson & Johnson", added the president of Aifa.

The uncertainty of the protocol

The crux therefore remains the uncertainty of a protocol, of shared guidelines for carrying out treatments directly at the patients' homes. About a year after the onset of the pandemic, the weak points on which to intervene are emerging and which probably required the establishment of a new red zone in many regions of Italy. 

The protests of the infectious disease specialists of the Sant'Orsola of Bologna 

A few days ago the case of the infectious disease specialists of the Sant'Orsola hospital in Bologna broke out, who in a letter criticized the cortisone-based treatments suggested by general practitioners. " Patients are arriving, even young ones , with severe Covid-19 whose only risk factor is the fact of having started cortisone therapy prematurely", reads the letter from the Bolognese infectious disease specialists. A treatment based on courtesy, which, if started too early, would do more harm than good. 

Zangrillo and Burioni: "Condemning cortisone abuse"

To relaunch and confirm the thesis of the letter from the doctors of Sant'Orsola also Professor Alberto Zangrillo, head of the Anesthesia and Intensive Care Unit of the San Raffaele hospital, who last Saturday wrote on his Facebook profile: "The majority of accesses Covid-19 in the emergency room are caused by absent or incorrect home therapies . For the abandonment of the patient and cortisone at the first line of fever, Italy is in the red ”. 

Appeal shared and relaunched by virologist Roberto Burioni : “Vaccines are important, but it is equally important not to give patients therapies that are not only useless , but even dangerous . In the initial stages of Covid-19, cortisone is contraindicated ". The Fimmg returned the accusations to the sender, brandishing the utterances as "defamatory and arrogant" messages. 

The guidelines of the Ministry of Health and Aifa 

Last December the Ministry of Health issued a circular on the “ Home management of patients with SARS-CoV-2 infection ”. The text specifies that cortisone is recommended for those patients whose "clinical picture does not improve within 72 hours , if in the presence of a worsening of pulse oximetry parameters requiring oxygen therapy". But the same is not recommended for people with chronic diseases because it can "cause important adverse events that risk complicating the course of the viral disease". The same advice is contained in the Aifa guidelines . 

What happens in Germany and France 

In France , just like in Italy, with mild symptoms such as cough, fever, headache, at home, paracetamol should be taken. In Germany for the non-hospitalized patients, the pharmacological approach is oriented to the treatment of symptoms with paracetamol, metamizole, ibuprofen. Home oxygen therapy is performed in very rare cases. In Germany, cortisone is not prescribed at home and even in the hospital it is administered to selected cases.

This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/giallo-sulle-linee-guida-per-i-medici-di-base-con-le-cure-a-casa-dei-pazienti-covid/ on Tue, 16 Mar 2021 06:00:08 +0000.